Exam 2: Ocular Manifestations of Hematologic and Systemic Diseases

Question 1

Leukemia features a neoplastic proliferation of WBCs in bone marrow. It is classified by the type of cell that has undergone the malignant transformation. Which type is more common in adults?

Answer 1

Myeloblastic

Question 2

Leukemia features a neoplastic proliferation of WBCs in bone marrow. It is classified by the type of cell that has undergone the malignant transformation. Which type is more common in children under 10 years?

Answer 2

Lymphoblastic

Question 3

What percentage of patients with leukemia have some ocular finding? What conjunctival finding may be present?

Answer 3

50-70%

Unilateral or bilateral comma/corkscrew conjunctival vascular anomalies may be present

Question 4

In early leukemia, what posterior segment findings may be present?

Answer 4

Venous dilation and tortuosity

Question 5

In late leukemia, what posterior segment findings may be present?

Answer 5

Hemorrhages, exudates, CWS, ON infiltration, and Roth spots

Question 6

What is the name of the cancer that features increased IgM fraction of the plasma? Does this typically happen in older or younger patients? What sorts of ocular findings does it feature?

Answer 6

Waldenstrom’s macroglobulinemia
Typically occurs in older patients
Findings include dilated/tortuous veins, hemorrhages, and Roth spots (similar to other anemias)

Question 7

Lipemia retinalis occurs with greatly increased triglyceride levels. Fasting glucose and total cholesterol levels can also be high in this condition. The elevated levels are listed below. List the normal levels.

Fasting glucose: >200mg/dL
Total cholesterol: >1000mg/dL
Triglyceride: >10,000mg/dL

Answer 7

Normal levels:

Fasting glucose: 60-120mg/dL
Total cholesterol: 120-220mg/dL
Triglyceride: 50-149mg/dL

Question 8

Retinal findings of lipemia retinalis occur once triclyeride levels are around what level?

Answer 8

About 2500mg/dL

Question 9

In lipemia retinalis, the retinal arteries and veins can be hard to differentiate. What color do the vessels tend to be? What other retinal findings may be present?

Answer 9

The vessels are salmon pink to ivory in color.

The rest of the retina is typically normal.

Question 10

Treatment for lipemia retinalis involves dieting and meds to control the triglyceride levels. What age range of patients are often affected by this condition? How is their VA affected?

Answer 10

Age range: 10-40 years (many pts)

VA: normal

Question 11

Behcet’s disease affects _________ (younger/older) adults and is more severe in _______ (men/women). What ethnicity do these patients tend to be?

Answer 11

Affects younger adults; more severe in men.

Japanese and Mediterranean ethnicity.

Question 12

What is the classic triad of findings of Behcet’s disease? What other findings may be present?

Answer 12

Aphthous stomatitis (mouth ulcers), genital ulcers, and recurrent hypopyon iritis (bilateral, with posterior involvement such as disc hyperemia, CME, ischemic vasculitis, retinal exudation)

Other findings may include joint pain, eye swelling/inflammation and pain.

Question 13

Treatment for Behcet’s disease includes topical and periocular steroids for the uveitis, as well as oral steroids and/or immunosuppressive drugs such as what?

Answer 13

Chlorambucil, cyclosporine.

Question 14

True or false: the prognosis for Behcet’s disease is good.

Answer 14

False; it is a poor prognosis

Question 15

Sarcoidosis features formation of granulomas, especially in the lungs and lymph nodes. What gender, race, and age group are most often affected with this condition?

Answer 15

Female, black, and young (20-40 years)

Question 16

What are the most common initial symptoms of sarcoidosis?

Answer 16

Persistent dry cough, fatigue, SOB

Question 17

What tests can be done in the diagnosis of sarcoidosis?

Answer 17

Chest x-ray, pulmonary function tests, bronchoscopy, ACE, calcium metabolism (hypercalcemia in most with sarcoid), granuloma biopsy)

Question 18

Ocular involvement in sarcoidosis occurs in ______% of patients, and can include what findings?

Answer 18

25-50% of patients
Lacrimal gland enlargement, granulomatous anterior uveitis (bialteral with mutton-fat KPs, iris nodules), conj lesions, vitritis or string of pearls in vitreous, periphlebitis (candle-wax drippings), retinal vein occlusions or rhemorrhages, disc edema.

Question 19

Patients with sarcoid will likely require management for dry eye. Their ocular condition is usually managed with cycloplegic agents, steroids (topical, possibly periocular and oral as well), and maybe immunosuppressant therapy. Which immunosuppressant can be used that may cause problems in the macula?

Answer 19

Hydroxychloroquine; can cause bull’s eye maculopathy

Question 20

True or false: though the prognosis for sarcoidosis can vary, more it is fatal for more than 50% of patients.

Answer 20

False; fatality is at 5-10%.

Question 21

What body parts are most often affected in lupus?

Answer 21

Skin, joints, blood, and kidneys

Question 22

What gender and age group are most often affected with lupus? Is it more or less common in Caucasians compared to blacks, American Indians, and Asians?

Answer 22

Female and young (20-40 years). Less common in Caucasians.

Question 23

There are many findings which can be used to diagnose lupus. At least four of which findings are necessary to suspect lupus?

Answer 23

Malar rash, discoid rash, sun rash, painless oral ulcers, arthritis in two or more peripheral joints, serositis, renal dysfunction (elevated protein in urine), seizures/psychosis, hemolytic anemia or leukopenia, positive ANA, positive anti-DNA or anti-Sm

Question 24

Lupus may feature what findings in the posterior segment?

Answer 24

CWS, retinal hemorrhages, Roth spots

Question 25

Treatment for lupus can include what classes of drugs?

Answer 25

NSAIDs, acetominophen, steroids, antimalarials (chloroquine/hydroxychloroquine), other immunomodulating drugs, and anticoagulants